The joint federal-state health program allows the federal government to give states 50 cents for every dollar they spent on purchasing health coverage for the poor and needy.

It has caused Medicaid to grow astronomically and is now the biggest ticket item on virtually every state budget.

It’s not only expensive, but it provides terrible coverage, too.

Obama dumped money into states so they could expand Medicaid even further.

He told states the feds would pick up 100% of the tab for the first three years for every additional person they covered (up to 138% of the poverty level).

After that, he would still pay 90% in perpetuity.

The District of Columbia and 31 states took that offer; 19 states refused.

Of the 16.6 million Americans who were covered by Obamacare between December 2013 and September 2016, 2.8 million did so via private coverage.

The balance, an incredible 13.8 million, got it through Medicaid and its companion program for children, CHIP.

One of the dirty little secrets of Obamacare is that many of its Medicaid enrollees are people kicked off their private plans due to the Medicaid expansion, so the law may have cost lives, rather than saved lives.

Medicaid now covers almost 75 million Americans. Even before Obamacare, Medicaid paid for almost half the births in America.

But can America sustain the cost?

The program’s combined annual price tag exceeds half a trillion dollars, with the feds share at 63% and the states at 37%.

That adds up to about $7,000 for every adult and child in the program.

Medicaid patients face far longer wait times to see primary care doctors, specialists, or get surgery.

Often, they end up in the emergency room just like the uninsured.

And in non-emergency situations, the uninsured might in fact get better care than Medicaid patients because doctors have more flexibility to charge them market prices.

In a University of Virginia study of 893,658 patients in the university hospital, it found that individuals on Medicaid had the worst post-surgery survival rate of any patients, including the uninsured, after controlling for age, health status, income and other relevant factors.

How to fix this problem?

For starters, here are two good ideas:

Block grant Medicaid and give states an annual lump sum tied to inflation, basically ending the open-ended entitlement that’s burning a hole in federal and state coffers.

A Health Savings Account — basically a tax-free IRA — to pay for routine care and other out-of-pocket expenses. Any balance at the end of the year would roll over into the next year

The Congressional Budget Office has estimated that block grants could cut Medicaid spending by up to a third over a decade.

This would curb healthcare inflation and lower overall spending.

Meanwhile, the Senate is trying to come together with a repeal and replace to Obamacare.

As Republicans try to reach a compromise, the media has entered the fray with fake news of deep Medicaid cuts.

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Why are we doing this?

For decades, the Republican Party and other organizations have focused on the handful of swing districts they thought were “winnable” or favored establishment candidates.

Because of this strategy, the Republican candidate in hundreds of districts is just a name on a ballot, abandoned and unable to spread a message about common-sense policies to the people who need to hear about them most. Activists in those districts are left without a cause to rally around, and voters are left without a real choice.